Clinical Citations: Comparing the features of invasive aspergillosis with and without neutropenia

Invasive aspergillosis is a common and often deadly infection in immunocompromised patients, such as neutropenic patients who are being treated for malignancies. Does it have similar features and outcomes in nonneutropenic patients? This study by Cornillet and colleagues provides some interesting answers.

They studied 88 patients with invasive aspergillosis (12 histologically proven, 52 probable, and 24 possible). The diagnosis was made in an intensive care unit in 47% of cases and in a hematology unit in 40%. Nearly 60% of the patients had neutropenia; most of these patients had hematologic or solid organ malignancies. The nonneutropenic patients had underlying conditions, such as chronic obstructive pulmonary disease, asthma, and rheumatoid arthritis, for which they were receiving corticosteroids.

The overall mortality rate was 71.5%. The mortality rate was significantly higher in nonneutropenic patients (89%) than in neutropenic patients (60%). The nonneutropenic patients were less likely to have symptoms of invasive aspergillosis and were more likely to have concomitant pneumonia caused by another pathogen.

The diagnostic sensitivity of antigenemia was the same for the 2 groups. However, bronchoalveolar lavage had greater diagnostic sensitivity in nonneutropenic patients.